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Individual

MICHAEL ADAM HEFFERNAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PT

Contact information

Practice address
2032 NEW CASTLE AVE, NEW CASTLE, DE 19720-7703
(302) 654-1700
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
J10002603
DE

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
P01052106
MEDICARE RAILROAD
DE
Enumeration date
06/23/2010
Last updated
03/20/2015
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